Adverse Childhood Experiences, Substance-Related Disorders
Conditions
Keywords
Adverse Childhood Experiences, Strengthening Families Program, Family Advocate, Community-level interventions, Hybrid Type 1 Design, Mixed-Method Evaluation, Effectiveness Trial, Cluster Randomized Controlled Trial, Process Evaluation, Cost Evaluation
Brief summary
Primary Objective: Conduct a rigorous evaluation of a prevention-based intervention designed to mitigate the harms of adverse childhood experiences (ACEs) exposure and prevent future ACEs, substance use, and overdose within 36 communities experiencing a disproportionate burden of substance use and ACEs. The study has three aims: (1) use a cluster randomized controlled trial to test effectiveness of the Strengthening Families Program (SFP) + Family Advocate (FA) intervention on substance use, overdose, and ACEs in 18 communities compared with SFP-only in 18 communities; (2) conduct a robust process evaluation informed by the Consolidated Framework for Implementation Research (CFIR) to explore implementation barriers and facilitators; and (3) conduct a cost evaluation to accurately estimate the costs required to implement SFP and SFP+FA and assess the cost-effectiveness of SFP+FA relative to SFP alone. Findings will provide a roadmap about the best ways to help disproportionately affected communities prevent substance use, overdose, and ACEs.
Detailed description
Early exposure to Adverse Childhood Experiences (ACEs), such as parental substance use, increases the likelihood of future substance use and drug overdose, resulting in an intergenerational cycle of substance-related ACEs that can continue indefinitely if left uninterrupted. Community-level interventions may moderate the relationship between ACEs and substance use by providing an array of family support services and treatments to reduce disparities and improve reach and service linkages in the community. Although research suggests that effectively decreasing the prevalence and impact of ACEs and substance use requires addressing both family- and community-level factors in tandem, there is a critical gap within the evidence base pertaining to interventions that effectively integrate the two factors to prevent substance use and ACEs. RTI International and its partners, the New Jersey Prevention Network and RWJBarnabas Health, will evaluate an intervention integrating New Jersey's established, evidence-based Strengthening Families Program (SFP) with clinically trained, trauma-informed Family Advocates (FAs) who will assist families (i.e., parents/caregivers and youth between the ages of 12 and17) in accessing community resources. Specifically, this study will use a Hybrid Type 1 effectiveness-implementation design across 36 New Jersey communities experiencing a disproportionate burden of substance use and ACEs.
Interventions
BEHAVIORALStrengthening Families Program + Family Advocate
This intervention will integrate clinically trained, trauma-informed Family Advocates (FA) into the established, evidence-based Strengthening Families Program (SFP). Families will participate in the SFP7-17 curriculum, which consists of 11 sessions over 10-14 weeks. FAs will assist families in accessing community resources for substance use and Adverse Childhood Experiences (ACE) prevention and treatment.
BEHAVIORALStrengthening Families Program
This intervention consists of the SFP7-17 Group Class Curriculum. Families will participate in the SFP7-17 curriculum, which consists of 11 sessions over 10-14 weeks.
Sponsors
RTI International
New Jersey Prevention Network
RWJBarnabas Health Institute for Prevention and Recovery
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
7 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
To be eligible to participate in this study, a family must meet all of the following criteria: * Either reside in, or attend SFP meetings, within one of the 36 New Jersey communities with disproportionate levels of ACEs and substance use disorder (SUD) issues that are assigned to either the treatment or control conditions via the study's cluster randomized controlled trial design * Meet family eligibility requirements: * One or more adult caregivers * One or more adolescents, ages 7 to 17 * Caregiver provision of signed and dated informed consent form * For children, informed assent and parental permission via the informed consent to participate in the study * Stated willingness to comply with all study procedures and lifestyle considerations and availability for the duration of the study * Willingness to adhere to the regimens of the SFP and FA interventions * Access to necessary resources for participating in a technology-based intervention (i.e., computer, smart phone, internet access)
Exclusion criteria
A family who meets any of the following criteria will be excluded from participation in this study: * Caregiver has previously completed SFP with one or more children, ages 7 to 17 * Intellectual disabilities (i.e., cognitive impairments that would prohibit the completion of the SFP curriculum or data collection instruments) * Language difficulties (caregivers and children must read and understand spoken English)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Substance use prevalence | Baseline, intervention completion (ranging from 10 to 14 weeks), and 6-month post-intervention follow-up | Measure of substance use prevalence among parents/caregivers and youth derived from 4 questions included on the SFP adult and SFP youth pre-test, post-test, and 6-month follow-up surveys. These 4 questions focus on whether various substances were ever used, used in the past 30 days, on how many day substances were used (if any), and which substances were used. |
| Substance use perceptions of harm | Baseline, intervention completion (ranging from 10 to 14 weeks), and 6-month post-intervention follow-up | Measure of substance use perceptions of harm among parents/caregivers and youth derived from 3 questions included on the SFP adult and SFP youth pre-test, post-test, and 6-month follow-up surveys. These 3 questions focus on perceptions of harm associated with alcoholic beverages, marijuana, and prescription drugs. |
| Referrals to clinical services | Baseline, intervention completion (ranging from 10 to 14 weeks), and 6-month post-intervention follow-up | Measure of rate of referrals to clinical services among participating families using the study's Weekly Clinical and Non-Clinical Services Referral Log |
| Referrals to non-clinical services | Baseline, intervention completion (ranging from 10 to 14 weeks), and 6-month post-intervention follow-up | Measure of rate of referrals to non-clinical services among participating families using the study's Weekly Clinical and Non-Clinical Services Referral Log |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ACEs prevalence | Baseline and 6-month post-intervention follow-up | Measure of ACEs prevalence among parents/caregivers and youth in participating families using 3 questions from the study's pre-test and 6-month post-test ACEs/Social Needs Screener. These 3 questions focus on the prevalence of the three main ACEs categories of abuse, neglect, and household challenges. |
| Social needs prevalence | Baseline and 6-month post-intervention follow-up | Measure of social needs prevalence among parents/caregivers and youth in participating families using 18 questions from the study's pre-test and 6-month post-test ACEs/Social Needs Screener. These 18 questions correspond to 5 social determinants of health domains (including house, food security, transportation, finances, and personal safety) from the American Academy of Family Physicians' social determinants of health screening tool. |
| Substance use risk | Baseline, intervention completion (ranging from 10 to 14 weeks), and 6-month post-intervention follow-up | Measure of substance use risk among parents/caregivers and youth derived from 3 questions included on the SFP adult and SFP youth pre-test, post-test, and 6-month follow-up surveys. These 3 questions focus on ease of access to different types of substances that may increase risk of substance use. |
| System linkages | Baseline and 6-month post-intervention follow-up | Measures of change in clinical and non-clinical referral networks (such as changes in network size, edges, density, centrality, reciprocity, triadic closure, and assortativity) using questions included on the study's pre-test and 6-month post-test community service provider survey |
| Average start-up cost | Pre-implementation | Measure of average cost per agency of starting up a program to deliver the intervention or active comparator using data from the study's Costing Instrument and Interview and administrative data from the New Jersey Prevention Network |
| Intervention cost | Intervention start to intervention completion (ranging from 10 to 14 weeks) | Measure of intervention cost at the participant level of delivering the intervention or active comparator using data from the study's Costing Instrument and Interview, 4 questions from the Intervention Cost Survey for SFP Facilitators, and 2 questions from the Intervention Cost Survey for Family Advocates |
| Cost per service referral | Intervention start to intervention completion (ranging from 10 to 14 weeks) | Measure of cost per service referral at the participant level using data from outcomes 6, 7, and 12, comparing cost per service referral for treatment and active comparator |
Countries
United States
Contacts
CONTACTAndrea L. Zapcic, BA
CONTACTBrittany Simon, MA
PRINCIPAL_INVESTIGATORPhillip W. Graham, DrPH
RTI International
PRINCIPAL_INVESTIGATORDallas J Elgin, PhD
RTI International
Outcome results
None listed